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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197414086
Report Date: 12/02/2019
Date Signed: 12/02/2019 11:12:20 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1605 EAST PALMDALE BLV, STE A
PALMDALE, CA 93550
FACILITY NAME:MARTINEZ FAMILY CHILD CAREFACILITY NUMBER:
197414086
ADMINISTRATOR:MARTINEZ, HEATHERFACILITY TYPE:
810
ADDRESS:TELEPHONE:
(661) 373-8107
CITY:CASTAICSTATE: CAZIP CODE:
91384
CAPACITY:14CENSUS: 0DATE:
12/02/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Heather MartinezTIME COMPLETED:
11:15 AM
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On December 2, 2019 at 10:00am Licensing Program Analyst (LPA) Loyce Phillips arrived at Martinez Family Child Care Home to conducted an unannounced Annual/Random inspection. Upon arrival Licensee had no children in care and stated she is currently closed due to a family emergency. Per Licensee is no longer interested in providing child care services at the current moment and wishes to go inactive. LPA printed out Request for Inactive Child Care License Status LIC 9211 for Licensee to complete as of 12/02/19.
SUPERVISOR'S NAME: Claretta YatesTELEPHONE: (661) 789-6944
LICENSING EVALUATOR NAME: Loyce PhillipsTELEPHONE: (661) 789-6944
LICENSING EVALUATOR SIGNATURE:

DATE: 12/02/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2019
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
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